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*ET

Wisconsin Department of Employee Trust Funds PO Box 7931. Madison WI 53707-7931. Direct Deposit authorization 1-877-533-5020 (toll free). Fax 608-267-4549. See Page 2 for important direct deposit information. Direct Deposit is not available for direct rollovers. Information About You Name (first, middle, last, former/maiden) Member ID or SSN. If you have multiple accounts at ETF, please check one: For beneficiaries only: Original Apply to benefit account ID(s):_____ participant's ETF Member ID or SSN. Apply to all accounts Address (Street or PO Box, city, state, ZIP code). Daytime phone number Check this box if you want the above address as your mailing address.

Savings a. Account number . Checking account ccount Owner(s) of this account . Authorization I authorize the Department of Employee Trust Funds and the financial institution named above to automatically deposit funds I am

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